Evaluating Implementation and Impact of PeerOnCall, a Mobile Health Approach to Peer Support for Canadian Public Safety Personnel

Advancing Peer Support Programming to Address PTSD and Trauma Among Canadian Public Safety Personnel and Veterans

A prospective cohort study design will be implemented across four sectors and multiple organizations sites to evaluate implementation and impact of the apps. Pre/post impact data will be collected over a six-month implementation period to assess whether the apps lead to increased Public Safety Personnel outreach to peer support (primary outcome), and to increased mental health literacy, and decreased mental distress (secondary outcomes). Recruitment will take place at three levels; 1) organizations (including knowledge users/organization champions), 2) peer support providers, and 3) public safety personnel employed within each participating organization. Sources of implementation and impact data for the six-month trial will include: 1) app utilization data, 2) knowledge user/organization champion interviews, 3) surveys with public safety personnel, 4) focus groups with peer support providers, and 5) implementation costs. Analysis will focus on both implementation and effectiveness to address the research questions related to the impact of the apps, as well as how the process and context of implementation shapes effectiveness.

Study Overview

• Status: Active, not recruiting
• Conditions: Post Traumatic Stress Disorder; Mental Stress; Mental Health Issue
• Intervention / Treatment: Other: PeerOnCall

Detailed Description

PeerOnCall was developed to support frontline PSP and includes features such as anonymous calling or messaging to a choice of peer support providers, access to self-screening tools, a personal wellness toolbox, and "tips to cope" resources. PeerOnCall Support is designed for peer support providers to provide a secure, private platform for providing support to peers who reach out via text or telephone through the PeerOnCall app.

This study will explicitly scale implementation and evaluation of these apps in the context of day-to-day work within a range of PSP organizations across four different service sectors (corrections, emergency communicators, fire services and paramedic services).

The implementation period for the app is six-months. Prior to the end of the six-month implementation period, the sector lead will meet with each organization to review app utilization data and to discuss options for continued usage of the app within the organization.

The Consolidated Framework for Implementation Research (CFIR) will inform exploration, not only of whether the apps 'work', but also about how the apps are adopted, and the individual and organizational forces that shape adoption.

The study will deploy the apps to a purposive sample of approximately 24 organizations across four sectors: 1) correctional workers; 2) emergency communicators (e.g., 911 call takers, dispatchers); 3) fire services; and 4) paramedic services. All participating organizations must have an established internal peer support service (with procedures for vetting, training, and ongoing support of the peer support providers), an organization champion who will liaise between the research team and employees, and support from leadership to participate in the study. The process of recruitment will be facilitated by sector leads and knowledge users who have extensive networks within the sectors. The number of organizations recruited across each sector will be different, recognizing differences in how services are provided, and the need for understanding breadth versus depth of implementation in key stakeholder groups.

Within each sector, key knowledge users (at the sector level) and organization champions (at the organization level) will be recruited. The sector-level knowledge users will provide insights into general considerations for implementation and evaluation. In the participating organizations, one or two "champions" will be recruited who will be responsible for organization onboarding, including customizing content, securing participation of in-house peer support providers, and sharing information with co-workers via formal and informal communication channels.

Peer support providers within each organization will be recruited to provide services through the app. All trained peer providers within each organization will be invited to participate. Information meetings will be held in each organization for the peer supporters regarding the PeerOnCall Support app. The orientation will ensure that the peer supporteres are aware of how to use the app and the protocols for responding to PSP who reach out for support, including those who may be in crisis.

All eligible employees within each organization will be invited to participate in the research via established communication channels within the organization (e.g., recruitment posters distributed via email, social media etc.), and information meetings held in the organization in the month prior to distributing access to the PeerOnCall app. After orientation within the organization, employees will be provided with an organization code to access the PeerOnCall app once it has been downloaded from the Google Play or Apple store. Employees can choose whether to download the app and they are able to use the app without engaging in the baseline and follow-up surveys.

To ensure adequate power for evaluating impact of the app, sample size estimates were based on the primary outcome of interest: the frequency of outreach to peer support through the app (count of the number of times contact was initiated by PeerOnCall users via phone and/or text). The sample size was calculated using a one-sided Poisson test since the frequency of outreach via the app can only increase from no outreach at baseline. Assuming 90% power, a significance level of 0.025 for a one-sided test, a hypothesized rate of 0.2 (20% increase in rates of outreach) and alternative hypothesis rate of 0.1 (thus a difference of 0.1), 161 participants will be required. Considering an estimated 20% drop out rate, 202 participants will be needed.

Aggregate data collected will include participant adoptions rates across each organization (e.g., the number of times the app was downloaded) as well as aggregate data on how often the app was used, average durations of use, the number of times different features were accessed, and the number and duration of contacts with peer supporters.

Knowledge user/Organization Champion Interviews will be conducted at baseline, three-months and six-months after app implementation begins at each participating organization to explore the context for implementation. Interview questions will be congruent with the Consolidated Framework for Implementation Research. These data will be used to identify facilitators and barriers to app use and inform interpretation of the adoption rates and outcome data both within and across participating organizations.

To track immediate feedback about the peer support service, a 'pop-up' feedback survey is presented to users within the application following each peer support encounter asking for a rating of their level of distress before and after the interaction using a 10-point Visual Analogue Scale. There is also an option to provide comments about the encounter. Data from the feedback surveys will help understand the immediate impact of peer support on level of distress.

To evaluate user impact over time, employees in each organization will be invited to complete baseline, three-month, and six-month follow-up surveys via a link to complete a survey.

Focus groups will be scheduled at three-months and six months after the implementation period with PeerOnCall Support peer support providers to explore their experiences with providing peer support through the app. Three sets of focus groups will be conducted within each sector with six to eight participants in each group.

Data regarding implementation costs within each organization will include: the organization champion's time invested on onboarding and communication, administrative time for uploading users and responding to requests, and metrics regarding peer support service provision. The cost of server hosting, troubleshooting, and regular upgrades to the apps will also be tracked across sites.

Implementation within each organization will be tracked via descriptive data regarding adoption rates (proportion of employees who download & use the app), and usage rates over time, including the number of times users reach out for peer support via phone/text, and the number of repeated calls.

To evaluate effectiveness, analysis of the pre/post survey data will examine the change in scores across the dataset in dimensions of mental health literacy, levels of mental distress (standardized assessments of anxiety, depression, and Post Traumatic Stress Disorder), and frequency of outreach behaviors in seeking mental health support. Multiple hierarchical linear regression analyses will be conducted to examine differences in effectiveness based on gender, service, and job tenure.

Effectiveness of the peer support service will also be evaluated by comparing change scores in level of distress before and after each peer support encounter via the in-app surveys.

Identification of barriers and facilitators to adoption of the technology and peer support service will occur through qualitative content analysis of the interview transcripts with the organizational champions and focus groups with the peer supporters. The CFIR framework will guide the analysis process considering organization internal and external forces, as well as how communication strategies influence implementation, and consistency in providing the peer support service.

All the data from the evaluation process will be reviewed to generate recommendations for optimizing uptake and impact of the app across different types of organizations.

• Study Type: Observational
• Enrollment (Actual): 950

Contacts and Locations

• Study Contact: Name: Sandra E Moll, PhD; Phone Number: 9054672155; Email: molls@mcmaster.ca
• Study Contact Backup: Name: Marilyn E Swinton, MSc; Phone Number: 289-244-3997; Email: swinton@mcmaster.ca

Study Locations

• Canada
  • Newfoundland and Labrador
    • Saint John's, Newfoundland and Labrador, Canada
      • Memorial University of Newfoundland
  • Ontario
    • London, Ontario, Canada, N6A 3K7
      • Western University
    • Waterloo, Ontario, Canada, N2L 3C5
      • Wilfrid Laurier University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Individuals employed by participating Public Safety Organizations (fire services, paramedic services, emergency communications, correctional services).

Description

Inclusion Criteria:

• Public Safety Personnel working in fire services, paramedic services, emergency communications and correctional services
• Employed (full or part-time) by the participating organizations
• Agree to download the PeerOnCall app on their mobile phone (Android or Apple)

Exclusion Criteria:

- Not able to access the app on their mobile health device

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accessing peer support via phone or text via the PeerOnCall app (Frequency count)	Number of times PeerOnCall users within an organization create a connection with peer support providers via the app platform (Software analytics)	Monthly intervals from 1 to 6 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Mental Health Literacy (6 items, 7-point Likert scale rating)	Rating using a 7-point Likert scale of perceived improvement in dimensions of mental health literacy (Promote mental health, knowledge of how to identify and address mental health issues in self and others, how to identify relevant resources). Range 7-42 with higher scores indicating higher levels of perceived literacy.	Baseline, 3 months, 6 months
Changes in symptoms of anxiety (GAD-7 screening tool)	The Generalised Anxiety Disorder (GAD-7) scale is a 7-item tool to evaluate anxiety symptoms over the past two weeks (4-point Likert scale ratings). Scores ranges from 0-21 with a score of 10 or more indicative of potential generalized anxiety disorder.	Baseline, 3 months, 6 months
Change in symptoms of depression (PHQ-9 screening tool)	The Patient Health Questionnaire (PHQ-9) is a 9-item screening tool for depression. Scores range from 0-27, with a score of 10 or more indicative of major depression.	Baseline, 3 months, 6 months
Change in symptoms of trauma (PTSD Checklist, PCL-5 short version)	The short version of the Post-Traumatic Stress Disorder Checklist (PCL-5) is a four-item PTSD screening checklist exploring responses to a stressful experience in terms of symptoms over the past month. Scores range from 0-16 with higher scores indicating more severe impairment.	Baseline, 3 months, 6 months
Change in help-seeking behaviour	Rating of how likely to reach out for support related to four different types of support (In-person peer support, app-based peer support, professional support, and employee assistance program). Ratings on a 5-point scale from not at all likely to extremely likely.	Baseline, 3 months, 6 months
Perceived value of the app	Questions about perceived impact adapted from the Mobile Rating Application Rating Scale (MARS) asks users to rate (on a 5-point Likert scale) the perceived value of the app on 7 items (Awareness of the importance of addressing mental health, reaching out for help and impact on mental health, perceived support, and ability to cope at work).	3 months, 6 months
Change in perceived level of stress	Rating of current level of stress on a 7-point Likert scale from very low to very high.	Baseline, 3 months, 6 months
Change in perceptions of workplace psychological health and safety climate	Rating of psychological health and safety climate in the workplace on a 7-point Likert scale from toxic to excellent.	Baseline, 3 months, 6 months
Change in current mental health challenges	Rating of current mental health challenges on a 100-point Visual Analogue scale from ill to healthy.	Baseline, 3 months, 6 months
Impact on work	Questions about the number of hours users were scheduled/expected to work and the number of hours of work users missed because of the way they were feeling over the past 2 weeks.	Baseline, 3 months, 6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Digital literacy	Rating of knowledge and comfort level in using apps. Ratings from low to high levels of digital literacy. Hypothesis is that lower digital literacy will predict lower app use. The baseline scale provides descriptive data about levels of digital literacy across the organization. The follow-up scale provides descriptive data about perceived digital literacy.	Baseline, 3 months, 6 months
Frequency of app use	Report of how often the app was used over the past 4 weeks, ranging from not at all to more than once a day. This data can be used to note dose/response (I.e., Higher app use might lead to greater impact) and to track app user over time.	3 months, 6 months
Timing of app use	Descriptive data of when the app is used the most. Can be used to report trends within/across sectors and organizations. This can also be used to cross-check with/against app utilization metrics.	3 months, 6 months
Rating of app	Users are asked to rate the value of 8 different features of the app on a 5-point Likert scale from very poor to excellent. Plus, an overall rating of the likelihood of continued use of the app on a 5-point Likert scale from definitely not to definitely.	3 months, 6 months

Collaborators and Investigators

• Sponsor: McMaster University
• Collaborators: Western University; Memorial University of Newfoundland; Public Health Agency of Canada (PHAC); Wilfrid Laurier University; University of Regina; Canadian Institute for Public Safety Research and Treatment; Fisheries and Marine Institute of Memorial University of Newfoundland
• Investigators: Principal Investigator: Sandra E Moll, PhD, McMaster University

Publications and helpful links

General Publications

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• Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Brehaut E, Negeri Z, Fischer FH, Benedetti A, Thombs BD; Depression Screening Data (DEPRESSD) PHQ Collaboration; Che L, Levis A, Riehm K, Saadat N, Azar M, Rice D, Boruff J, Kloda L, Cuijpers P, Gilbody S, Ioannidis J, McMillan D, Patten S, Shrier I, Ziegelstein R, Moore A, Akena D, Amtmann D, Arroll B, Ayalon L, Baradaran H, Beraldi A, Bernstein C, Bhana A, Bombardier C, Buji RI, Butterworth P, Carter G, Chagas M, Chan J, Chan LF, Chibanda D, Cholera R, Clover K, Conway A, Conwell Y, Daray F, de Man-van Ginkel J, Delgadillo J, Diez-Quevedo C, Fann J, Field S, Fisher J, Fung D, Garman E, Gelaye B, Gholizadeh L, Gibson L, Goodyear-Smith F, Green E, Greeno C, Hall B, Hampel P, Hantsoo L, Haroz E, Harter M, Hegerl U, Hides L, Hobfoll S, Honikman S, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jeon HJ, Jette N, Khamseh M, Kiely K, Kohler S, Kohrt B, Kwan Y, Lamers F, Asuncion Lara M, Levin-Aspenson H, Lino V, Liu SI, Lotrakul M, Loureiro S, Lowe B, Luitel N, Lund C, Marrie RA, Marsh L, Marx B, McGuire A, Mohd Sidik S, Munhoz T, Muramatsu K, Nakku J, Navarrete L, Osorio F, Patel V, Pence B, Persoons P, Petersen I, Picardi A, Pugh S, Quinn T, Rancans E, Rathod S, Reuter K, Roch S, Rooney A, Rowe H, Santos I, Schram M, Shaaban J, Shinn E, Sidebottom A, Simning A, Spangenberg L, Stafford L, Sung S, Suzuki K, Swartz R, Tan PLL, Taylor-Rowan M, Tran T, Turner A, van der Feltz-Cornelis C, van Heyningen T, van Weert H, Wagner L, Li Wang J, White J, Winkley K, Wynter K, Yamada M, Zhi Zeng Q, Zhang Y. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. JAMA. 2020 Jun 9;323(22):2290-2300. doi: 10.1001/jama.2020.6504.
• Zuromski KL, Ustun B, Hwang I, Keane TM, Marx BP, Stein MB, Ursano RJ, Kessler RC. Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5). Depress Anxiety. 2019 Sep;36(9):790-800. doi: 10.1002/da.22942. Epub 2019 Jul 29.
• Ramkissoon A, Smith P, Oudyk J. Dissecting the effect of workplace exposures on workers' rating of psychological health and safety. Am J Ind Med. 2019 May;62(5):412-421. doi: 10.1002/ajim.22964. Epub 2019 Mar 27.
• Plouffe RA, Nazarov A, Forchuk CA, Gargala D, Deda E, Le T, Bourret-Gheysen J, Jackson B, Soares V, Hosseiny F, Smith P, Roth M, MacDougall AG, Marlborough M, Jetly R, Heber A, Albuquerque J, Lanius R, Balderson K, Dupuis G, Mehta V, Richardson JD. Impacts of morally distressing experiences on the mental health of Canadian health care workers during the COVID-19 pandemic. Eur J Psychotraumatol. 2021 Nov 10;12(1):1984667. doi: 10.1080/20008198.2021.1984667. eCollection 2021.
• Pavolini E, Kuhlmann E, Agartan TI, Burau V, Mannion R, Speed E. Healthcare governance, professions and populism: Is there a relationship? An explorative comparison of five European countries. Health Policy. 2018 Oct;122(10):1140-1148. doi: 10.1016/j.healthpol.2018.08.020. Epub 2018 Sep 7.
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• Moll SE, Patten S, Stuart H, MacDermid JC, Kirsh B. Beyond Silence: A Randomized, Parallel-Group Trial Exploring the Impact of Workplace Mental Health Literacy Training with Healthcare Employees. Can J Psychiatry. 2018 Dec;63(12):826-833. doi: 10.1177/0706743718766051. Epub 2018 Apr 19.
• Moll S, Zanhour M, Patten SB, Stuart H, MacDermid J. Evaluating Mental Health Literacy in the Workplace: Development and Psychometric Properties of a Vignette-Based Tool. J Occup Rehabil. 2017 Dec;27(4):601-611. doi: 10.1007/s10926-017-9695-0.
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• Ricciardelli, R., Carleton, R. N., Cramm, H., & Groll, D. (2018). Qualitatively Unpacking Canadian Public Safety Personnel Experiences of Trauma and their Wellbeing: Physical Manifestations, Psychological Implications, and Fatalistic Attitudes. Canadian Journal of Criminology and Criminal Justice, 60, 566-577. Doi: 10.3138/cjccj.2017-0053.r2
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• Carleton, R. N., Afifi, T.O., Turner, S., Taillieu, T., LeBouthiller, D.M., Duranceau, S., Sareen, J., Ricciardelli, R., MacPhee, Krakauer, R., Anderson, G. S., Cramm, H. A., Groll, D., & McCreary, D. R. (2019). Exposures to potentially traumatic events among public safety personnel in Canada. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 51(1), 37-52. Doi: 10.1037/cbs0000115
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• Oliphant, R. (2016). Healthy Minds, Safe Communities. Supporting Our Public Safety Officers Through a National Strategy for Operational Stress Injuries. Report of the Standing Committee on Public Safety and National Security. Ottawa, ON: House of Commons.
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Helpful Links

• Estimated Veteran Population by Province
• CIPSRT COVID-19 Readiness Resource Project (CRRP)

Study record dates

Study Major Dates

• Study Start (Actual): May 2, 2023
• Primary Completion (Actual): March 31, 2024
• Study Completion (Estimated): April 1, 2024

Study Registration Dates

• First Submitted: June 19, 2022
• First Submitted That Met QC Criteria: June 19, 2022
• First Posted (Actual): June 23, 2022

Study Record Updates

• Last Update Posted (Actual): April 9, 2024
• Last Update Submitted That Met QC Criteria: April 8, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: mobile health; peer support
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Stress, Psychological
• Other Study ID Numbers: 14731

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: May share aggregate utilisation data without personal identifiers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No